India moves closer to polio end-game

The polio eradication programme in India – one of the biggest public health initiatives in the country – has achieved a major milestone. During the past two years, no polio cases has been reported.

The last child to be paralysed by the wild poliovirus in India was detected in January 2011. India was removed from the list of polio endemic countries by WHO in February 2012.

Estimates indicate that before the oral polio vaccine was introduced in India in 1978, nearly 500 children were being paralysed due to polio every day in the country. Since the launch of mass polio vaccination campaigns in 1995, it took India nearly 16 years to eradicate polio, to finally get rid of the wild polio viruses from the country.

Each nation-wide polio vaccination campaign in India involves vaccinating nearly 172 million children in more than 225 million households by 2.3 million vaccinators.

Reaching the vast population with diverse sociocultural practices, overcoming the geographical barriers, achieving high vaccination coverage in all urban and rural areas despite weaknesses in health systems and ensuring coverage of the most vulnerable newborns and migrant populations have been the major challenges that were overcome by the polio programme in India.

The programme involved the local religious leaders and institutions to solicit support and engagement of all sections of the society and implemented a special plan for 107 high-risk blocks of UP and Bihar to provide a complete package of health and sanitation services in addition to improving polio vaccination coverage in these blocks.

Improve acceptance

Indian celebrities were engaged to endorse the programme to enhance the visibility and improve acceptance of the polio vaccine. As a risk mitigation strategy, 81 posts along the Indo-Nepal border and five along the Indo-Pakistan border were set up to ensure continuous vaccination of all children crossing these borders.

New vaccines were introduced to address the challenges related to vaccine failures in areas with high force of poliovirus transmission and compromised vaccine efficacy due to environmental factors. The more efficacious monovalent oral polio vaccine (mOPV) was introduced in 2005 and the bivalent OPV in 2010 to break the last chains of poliovirus.

Surveillance for polio continued to operate at very high levels of sensitivity and speed. The surveillance system, including the laboratory performance, consistently surpassed the WHO recommended standards and global indicators of sensitivity. Sewage sample testing was conducted in Mumbai, Delhi, Patna and Kolkata to detect any wild polioviruses in the environment. Surveillance data were consistently used to prioritise and guide immunisation activities and strategies.

India’s progress and efforts have been lauded by both, national and international health experts and groups. The Independent monitoring board, convened at the request of the World Health Assembly to monitor and guide the progress of the global polio eradication initiative’s strategic plan, has in its various reports appreciated the Indian government and its polio partners for their coordinated efforts to reach zero status.

While tremendous progress has been made over the past many years and sustained over the past two years, India remains at a risk of polio resurgence through a distant or cross border importation of the wild poliovirus from countries where the virus continues to circulate. India has, during previous years, exported wild polioviruses to other countries.

The risk of the virus returning to India from any of the currently infected countries is a real one. India, therefore, needs to ensure that high immunity is maintained against poliovirus, the surveillance remains sensitive to pick up any importation and all states are in a state of emergency preparedness to respond urgently to any importation, if it were to occur.

India’s programme is now supporting the polio eradication initiative in the remaining polio endemic countries – Afghanistan, Nigeria, and Pakistan. Multiple missions comprising WHO, Unicef and other agency staff have gone to these countries during the past year to share and apply the information and knowledge acquired by the India programme over the past 16 years.

As it completes two years, India is also looking forwards to playing a role in the development of the polio end-game strategy, with support from WHO and other partners. The strategy involves a carefully planned phased withdrawal of the oral polio vaccines from the programme. India is a front runner in conducting research to support policy decisions as a part of the polio end-game strategy.

The momentum of success cannot stop; what India has achieved is truly monumental, but there is still work to do and complete. India cannot pause as long as wild poliovirus continues to circulate anywhere in the world. It has to sustain the efforts until global polio-free certification is achieved and all oral polio vaccines are withdrawn from the programme. (The writers are with the World Health Organisation)

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